Symptoms Of Meningiomas In Elderly Patients

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Overview

If you think of the brain as a bustling city, constantly alive with activity, each specific part of it contributes to the overall functioning of the city, the concept of a meningioma might become clearer. Imagine an unplanned construction site appearing in your city, causing disorder and disturbance. This is how a meningioma works in the city of your brain.

Meningiomas are brain tumours that originate from the meninges, the thin layers of tissue covering the brain and spinal cord, serving as a protective layer. Different genetic changes can affect the brain's protective layers (meninges), depending on the specific genetic alteration.1 Meningiomas typically grow slowly, much like a minor power issue in a city can evolve into a significant disruption if not attended to.2 However, some can grow rapidly, similar to a skyscraper shooting up in a city, highlighting the urgent need for action.2

In particular, intracranial meningiomas, a common type of brain tumour in elderly patients (with an age above 65 years), pose a unique challenge.3,4 Symptoms in the elderly can often be mistaken for the regular 'wear and tear' of the city or other age-related health issues, such as stroke or Alzheimer's disease.5,6 This article will delve into the mystery of meningiomas, particularly focusing on their appearance in elderly patients, exploring their symptoms, and shedding light on their management and treatment options.3,7

A brief explanation of meningioma tumours

Deciphering the nature of meningiomas calls for an approach as multi-layered as the intricate layout of a city. Meningiomas, previously mentioned, emerge from the meninges, the safeguarding layer encapsulating the brain and spinal cord. The World Health Organization (WHO) has a system for classifying meningiomas. According to this system, the majority of meningiomas, about 80%, are classified as Grade I.8 They are predominantly non-cancerous, akin to a slowly spreading weed in a garden.9 However, the remaining 20% of meningiomas are classified as Grade II or III.10 These minority tumours are referred to as atypical or anaplastic meningiomas, which are similar to 'weeds' spreading more rapidly and exhibiting more aggression.11 The histologic grading, based on the microscopic examination of tissue cells, better known as a  biopsy, acts as a compass, guiding the prognosis of a patient, the likelihood of recurrence, and the need for radiation or chemotherapy.12

Prevalence and incidence in the elderly population

As people age, brain tumours become increasingly frequent.13,14 Past research has shown that each year, between 1.2 and 3.1 out of every 100,000 people will be diagnosed with a specific type of brain tumour known as an intracranial meningioma.6 This type of tumour is particularly common in older adults. In recent times, as people are living longer and doctors are using more advanced imaging techniques to diagnose diseases, the number of diagnosed intracranial meningiomas, whether they're causing symptoms or not, has been on the rise in the elderly population.3,15 To put it in city terms, as the city ages, the likelihood of unwanted construction, namely, the emergence of meningiomas, increases.

Even though the majority of meningiomas are non-cancerous, their size and position can cause a variety of symptoms. This is much like how different disruptions may occur in a city due to a power outage or a traffic jam in varying locations. These symptoms may be amplified in elderly patients, due to the combination of age-related cerebral changes and the effects of the meningioma itself.16

Common symptoms of meningiomas in elderly patients

Synonymous  to a city's specific characteristics rendering a unique feeling, a meningioma can exhibit a wide array of symptoms, dependant upon its location and size. Within the elderly demographic, the following are common symptoms:

Headaches

Frequency, intensity, and location

Much like a city experiencing a sudden construction boom, headaches often pop up as the first sign of a meningioma.4 They can be frequent and intense, often worse in the morning or with sudden movements, much like unexpected construction noise in a city.17 Headaches are more likely to occur when the meningioma is located in the specific region supplied by the ophthalmic trigeminal branch, similar to how people in a neighbourhood are more likely to be bothered by noise if troublemakers set up camp there.18

Worsening patterns

Envisage your city confronting unexpected power blackouts, generating unease and trepidation. Analogously, abrupt, recurrent headaches present a similar situation. The intensity and location of these headaches can differ and typically exacerbate over time. A segment of patients report experiencing these headaches upon awakening, akin to a city roused by a surprise power failure.17

Neurological changes

Cognitive impairment

Some patients may experience difficulties with thinking, concentration, and decision-making, like a city's transport system getting disrupted.4,19

Memory loss

Some patients may have problems with short-term or long-term memory, like a city archive getting jumbled up.19

Personality changes

Changes in mood, behaviour, and personality can occur like a city's vibe changing over time.4,19 It mirrors a scenario where the city's administrative offices are in disarray, impacting overall functionality. Memory losses can render patients forgetful, while personality changes can result in uncharacteristic behaviours.

Seizures

Types of seizures experienced

A seizure provoked by a meningioma parallels a sudden citywide blackout.4 This can vary widely, from minor seizures that involve a small part of the body to major seizures that can cause a loss of consciousness, much like a city's electrical grid experiencing power surges and outages.17

Frequency and duration

The frequency and duration of these episodes can fluctuate considerably. Some patients may have frequent seizures, while others may only have a few like a city's electrical grid experiencing intermittent power outages.17

Visual disturbances

Blurred or double vision

A meningioma positioned near the optic nerve can create a scenario similar to a dust storm obscuring the city skyline. Patients might report blurred or double vision.20

Loss of peripheral vision

Some patients may lose their side (peripheral) vision, generating a 'tunnel vision' effect, like a city's surveillance cameras losing sight of the city's outskirts.20

Weakness and motor impairments

Muscle weakness

Meningiomas can induce symptoms like muscle feebleness and coordination difficulties, akin to the city's transportation system malfunctioning. This can occur if the tumour affects the parts of the brain that control muscle movement, like a city's transport system getting disrupted.21

Coordination difficulties

Some patients may have problems with balance and coordination like a city's transport system experiencing traffic jams and delays. Patients might grapple with tasks that were previously manageable, like the ability to walk without the need for any kind of assistance or object manipulation.21

Less common symptoms of meningiomas in elderly patients

Alongside the aforementioned symptoms, certain elderly patients may also encounter:

1. Speech difficulties

Slurred speech

Paralleling a city's communication lines becoming intermingled, patients might grapple with garbled speech. Some patients may have difficulty speaking clearly.19 It is as though the city's 'call centre' is encountering operational issues.

Difficulty finding words

Some patients may struggle to find the right words during conversation, like a city's communication network experiencing delays.19

2. Sensory abnormalities

Numbness or tingling

A peculiar sensation, akin to numbness or tingling can manifest in patients. This can occur if the tumour affects the parts of the brain that control sensation like a city's emergency alarm triggering without any discernible reason.20

Altered sensation

Some patients may experience changes in their sense of touch, temperature, or pain like a city's power supply experiencing fluctuations.20

Loss of smell or taste

Some patients may lose their sense of smell or taste, a symptom that can affect patients' pleasure in food and consequently influence their nutritional status. It's analogous to the city's food scene losing its flavor.21

Balance and gait problems

Some patients may have difficulty walking or maintaining balance like a city's transport system getting disrupted.21

Bowel and bladder dysfunction

In rare cases, patients may have problems with bowel or bladder control.21 This symptom parallels the city's waste disposal system going awry.

Lack of energy

Fatigue is the most frequently reported symptom, both in the immediate aftermath (acute) and the long haul (chronic).22 A study illuminates that patients who underwent surgery for meningioma, when surveyed within two years or even after two years following the procedure, highlighted "lack of energy" as their most pressing concern.

 This is akin to a city's power grid struggling to restore full power, suggesting a possible impact of the surgical procedure or anaesthesia on the city's (patient's) energy levels in both the short and long term.23 However, there's a noticeable gap in the literature when it comes to fatigue as a symptom directly linked to the tumour itself in meningioma patients, much like a city grappling with power outages but unsure of the root cause.23

Potential complications and red flags

Certain symptoms may function as alarm signals, indicating severe complications.

Increased intracranial pressure

Envision your city’s water supply network leaking, resulting in water accumulation and flooding. Similarly, some meningiomas might provoke a buildup of fluid in the brain, medically known as hydrocephalus.24,25 This condition can elevate the pressure within the cranium, culminating in persistent headaches, nausea, vomiting, and in grave cases, loss of consciousness.26

Signs of neurological deterioration

Neurological alterations such as the deterioration of coordination, escalating memory complications, or intensifying personality changes are comparable to the city's operations progressively failing. These could be indications of an enlarging or recurring meningioma, necessitating immediate medical intervention.3

Imagine a bustling city where people's daily activities represent its vitality. Now, picture a storm hitting the city, causing some disruption in its daily rhythm. In the context of our body, the storm is a medical condition like a meningioma, and the city's daily activities symbolize our physical functioning. This functionality is assessed using the Karnofsky Performance Status (KPS) score.27,28

The KPS score is like a weather report that gauges the 'storm's' impact on the city's daily life. It's a standard way doctors use to measure a patient's ability to carry out ordinary tasks or their need for assistance.29 A high KPS score, like 90 or 100, means the patient can go about daily life with little or no help, representing a city buzzing with activity despite the storm. On the other hand, a lower KPS score indicates that a patient needs more assistance with daily activities, similar to a city requiring help to recover post-storm.30

In the case of meningiomas, the 'storm', a low pre-operative KPS score could mean the patient is already experiencing significant disruption in their daily activities. This can affect their ability to tolerate treatment and their recovery process like a city already hampered by a storm facing challenges in rebuilding.30

Emergency symptoms requiring immediate attention

Mirroring a city’s emergency alarm triggering, specific symptoms demand immediate medical response. Abrupt, severe headaches, sudden loss of vision, new onset seizures, or a rapid decline in neurological functionality are serious symptoms requiring prompt attention.6

Treatment options for meningiomas

Just as a city planner would approach a major urban renovation, so too must healthcare providers strategize when treating a meningioma. The plan of action hinges on the tumour's location, size, and growth rate, as well as the patient's overall health status.

Watchful waiting

In some instances, when the meningioma is small, symptomless (akin to a silent construction site), and not growing rapidly, the healthcare provider might suggest a "wait and see" approach.31 This is like a city's fire drill - regular monitoring through imaging tests ensures that the city (i.e., the patient) is prepared and the situation remains under control.

Surgical treatment

When the meningioma causes significant symptoms or is growing rapidly (resembling a quickly rising skyscraper), surgical removal or resection may be necessary. The surgery, or "city renovation," can range from removing part of the tumour (partial resection) to removing the entire tumour (complete resection). This largely depends on the tumour's location at the skull base or elsewhere and the associated risks32.

Radiation therapy

Sometimes, the complete removal of a meningioma might not be possible, for instance, when it's too close to sensitive brain tissue. In such cases, radiation therapy can be used post-surgery to ensure the 'renovation' is complete. This includes Stereotactic Radiosurgery (SRS) and Fractionated Stereotactic Radiotherapy (FSRT), which precisely target the tumour, minimizing damage to surrounding healthy tissue.32

When we encounter atypical meningiomas (Grade II) or anaplastic meningiomas (Grade III), their aggressive nature is akin to a construction site causing significant disruption. In such scenarios, a dual approach of surgical removal and radiation therapy is frequently the course of action.32 This comprehensive strategy, much like a well-coordinated city-wide renovation, provides the greatest opportunity for management, especially when dealing with recurrent meningiomas.

Considerations for treatment in elderly patients

In the treatment of meningiomas in elderly patients, the approach must be as meticulous as a city planner who is tasked with preserving the charm of an old city while modernizing its infrastructure. Elderly patients often have other medical conditions that must be taken into consideration when evaluating their ability to undergo surgery and recover from the procedure.3

Following the principles of biomedical ethics,33 a comprehensive dialogue with the patient and their family is crucial to make informed decisions about the potential risks and benefits of treatment options such as surgery and radiation therapy. Surgery, akin to a major city renovation, may provide immediate relief from symptoms, but it also carries general risks such as seizures and hydrocephalus.32 Despite variations in categorization and preoperative Karnofsky Performance Status (KPS), some researchers have found no significant difference in mortality, complication rate, or long-term prognosis between younger and older patients after surgery for intracranial meningioma, much like how different city renovation projects may yield similar results regardless of the city's age.3,34 However, there is no broad agreement on surgical therapy of intracranial meningiomas in elderly patients, akin to city planners differing on the best approach to renovate an old city, and the risk factors for elderly patients with surgically removed intracranial meningiomas are not well documented.3,34

On the other hand, radiation therapy, including stereotactic radiosurgery, may be a less invasive option, similar to a subtle city refurbishment.35

Therefore, treatment decisions must be tailored to each patient's specific needs and circumstances, much like a city plan would be customized to fit the unique features of a particular area. This involves taking into account the characteristics of the meningioma and the patient's overall health status.3,36

Summary

Elderly individuals might face a variety of symptoms, including headaches, memory loss, seizures, and visual disturbances. There might also be less common signs, such as difficulties with speech and changes in smell or taste.

The management strategies for meningiomas in the elderly span from vigilant observation to surgical intervention and radiation therapy, depending on the specific circumstances. Much like managing a city, treating a meningioma calls for a thoughtful, strategic approach, particularly in elderly patients.

Above all, it's of utmost importance to seek medical help if you or someone you know starts experiencing any unexplained changes. The sooner the issue is identified and tackled, the quicker your city - the brain, can bounce back to its usual, bustling self.

References

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  23. Zamanipoor Najafabadi AH, Peeters MCM, Lobatto DJ, Broekman MLD, Smith TR, Biermasz NR, et al. Health-related quality of life of cranial WHO grade I meningioma patients: are current questionnaires relevant? Acta Neurochir [Internet]. 2017 Nov [cited 2023 Jun 22];159(11):2149–59. Available from: http://link.springer.com/10.1007/s00701-017-3332-8
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